09-11, 10:45–11:45 (Europe/Istanbul), Head & Neck Surgery 3
The management of head and neck cancer (HNC) requires a multidisciplinary, guideline-driven approach to optimize outcomes and minimize morbidity. Unfortunately, a subset of patients is still being treated outside of established protocols, often leading to suboptimal oncologic control, functional impairments, and complex salvage scenarios. This retrospective clinical reflection highlights several emblematic cases of inadequately treated HNC patients referred to our center for secondary management.
Our analysis focuses on patients who initially underwent incomplete, inappropriate, or delayed treatment in non-specialized centers. Common issues included: lack of proper staging before treatment, non-standard surgical approaches without clear margins, omission of adjuvant therapy when indicated, or poorly planned radiotherapy. These deviations frequently resulted in early recurrence, persistent disease, or major complications involving speech, swallowing, and airway integrity.
Through selected clinical cases, we explore the practical, ethical, and therapeutic challenges involved in managing these patients. Salvage treatments – whether surgical, radiotherapeutic, or systemic – are often technically more demanding and oncologically less effective than primary treatments delivered within guidelines. In addition, prior suboptimal treatment often compromises anatomical structures and patient performance status, making optimal recovery difficult.
This clinical case-based review also raises broader questions regarding referral practices, the role of second opinions, and the need for early multidisciplinary evaluation. It aims to prompt reflection among clinicians on the consequences of deviating from evidence-based care in HNC and to encourage systemic improvements in patient pathways. We also emphasize the psychological burden these patients carry and the difficulty in restoring their trust after prior mismanagement.
Ultimately, while reconstructive and salvage interventions are necessary and sometimes life-saving, they are rarely equivalent to getting it right the first time. Prevention, through timely referral and coordinated care in high-volume, specialized centers, remains the most effective and ethical solution.
This proposal aims to share real-world clinical experiences with inadequately treated head and neck cancer patients, highlighting the consequences of non-guideline-based care. Through selected case reflections, we seek to emphasize the importance of early, multidisciplinary management in specialized centers and to provoke critical discussion about systemic failures and potential improvements in oncologic pathways.
I am Dr. Alfred Aga, an Albanian-Italian otolaryngologist and Head of the ENT Department at the American Hospital in Tirana since 2012. I earned my medical degree from the University of Brescia, Italy, and completed fellowships in head and neck surgery at the National Cancer Institute in Rome and at Ohio State University in the USA. With experience in over 3,800 surgeries, my clinical focus includes head and neck oncology, reconstructive microsurgery, and endoscopic skull base surgery. I have received multiple awards, presented at numerous international conferences, and published several articles in peer-reviewed journals. Currently the president of Albanian society of Otorhinolaryngology H&N society and an active member of European ENT societies, fluent in both Italian and English.
I graduated in Medicine and Surgery in 2011 at the University of Brescia, Italy summa cum laude. In 2017 I completed the residency program in Otorhinolaryngology – Head and Neck Surgery summa cum laude in the same Institute under the guidance of Prof. Piero Nicolai. During my formative years I performed a visiting fellowship at the Section of Head and Neck Oncology of the University Hospital of Leuven, Belgium, and at the Division of Head and Neck Surgery of the University of Hong Kong.
During my training I dealt with head and neck oncology, rhinology, and endoscopic skull base surgery with special interest for oral cavity and maxillary and paranasal sinuses cancers. During my attendance at the University of Hong Kong I increased my experience in the management of some specific tumors such nasopharyngeal cancer.
I carried out my activity in 2017 at the Otolaryngology Unit of the Humanitas Clincal and Research Center - Rozzano (MI) and in 2018-2019, at the Otolaryngology Division of the Bolzano Hospital under the guidance of Dr. Luca Calabrese. In this period, I mainly dealt with advanced oncological surgery of the head and neck. I have also greatly developed my experience in functional surgery of the nose and paranasal sinuses. From 2020 to 2022, I worked at the Otolaryngology Department of the Ospedale Maggiore Policlinico in Milan, mainly dealing with rhinology, orbital surgery, and skull base surgery.
In 2022 I started my activity at the Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy where I am referent Consultant for Head and Neck and Skull Base patients.
Head and Neck surgeon and microscopic reconstruction surgeon wit particular focus on oral cavity cancers
Jeroen Meulemans graduated as a medical doctor at KU Leuven (Belgium) in 2010, and subsequently started training in otolaryngology and head and neck surgery. In 2015, he joined the staff of the department of otolaryngology, head and neck surgery in UZ Leuven and proceeded with finetuning his clinical experience by observerships in Brescia (It), Genova (It), Milan (It), Stuttgart (Germany), Seoul (S-Korea) and Vienna (Austria). He was awarded the Liechtenberger price by the European Laryngological Society in 2016 and the Young Investigator’s award by the European Head and Neck Society in 2023. In 2021, he obtained his PhD degree in Biomedical Sciences after successful defence of his thesis entitled: ‘Innovative surgical techniques in head and neck oncology – current technologies and applications and developments for the future’. He has a special interest in surgical treatment of thyroid cancer, in minimally-invasive (transoral) robotic and laser surgery of head and neck cancer and in reconstruction of laryngotracheal stenoses. Moreover, he is involved in the tracheal transplantation programme. His research focuses on evaluation of oncological and functional outcomes after primary minimally invasive surgery for head and neck cancer and after salvage surgery for recurrent cancers of the upper aerodigestive tract.